Abstract
Restless legs syndrome (RLS) is a common neurologic disorder that has been previously found to be associated with higher odds of suicidal ideation. In the context of the increasing suicide rate in the United States, the evidence regarding the association between RLS and the risk of suicide and self-harm is limited. To investigate the association between RLS and risk of suicide and self-harm. This cohort study was performed using Truven Health MarketScan national claims data from 2006 to 2014; the baseline data were from 2006 to 2008, and the follow-up data covered 6 years (January 1, 2009, to December 31, 2014). Included were 24 179 nonpregnant participants with RLS and 145 194 age- and sex-matched participants without RLS at baseline (2006-2008), who were free of suicide, self-harm, cardiovascular disease, or cancer at study baseline. Data analysis was performed from February 1, 2018, to January 1, 2019. Diagnosis of RLS, as identified by the International Classification of Diseases, Ninth Revision code. Incident suicide and self-harm event, identified by the International Classification of Diseases, Ninth Revision diagnosis code. Among 169 373 participants in the current analysis, the mean (SD) age was 49.4 (9.1) years; 53 426 (31.5%) participants were men. During a mean (SD) follow-up duration of 5.2 (2.2) years, 119 incident suicide and self-harm cases were identified. Individuals with RLS had a higher risk of suicide or self-harm compared with those without RLS (adjusted hazard ratio, 2.66; 95% CI, 1.70-4.15), after adjusting for lifestyle factors (eg, alcohol and obesity), presence of chronic diseases (eg, depression, insomnia, diabetes, chronic kidney disease, peripheral neuropathy, iron-deficiency anemia, and Parkinson disease), and use of medications. Excluding those with depression, insomnia, obstructive sleep apnea, and other common chronic conditions, the significant association between RLS and suicide or self-harm persisted (adjusted hazard ratio, 4.14; 95% CI, 2.17-7.92). Restless legs syndrome was associated with a high risk of suicide and self-harm, and the risk was independent of most identified diseases and conditions.
Highlights
Restless legs syndrome (RLS), which affects approximately 5% of the population in Western countries, is a sensorimotor disorder characterized by an unstoppable desire to move the legs and is usually accompanied by irritation in the lower extremities.[1]
Individuals with RLS had a higher risk of suicide or self-harm compared with those without RLS, after adjusting for lifestyle factors, presence of chronic diseases, and use of medications
In the age- and sex-adjusted model, individuals with RLS had a higher risk of suicide and self-harm compared with those without RLS
Summary
Restless legs syndrome (RLS), which affects approximately 5% of the population in Western countries, is a sensorimotor disorder characterized by an unstoppable desire to move the legs and is usually accompanied by irritation in the lower extremities.[1]. Given that sleep disturbance and depression are highly concurrent in individuals with RLS,[5,6,7,20] it is plausible that part of the elevated overall mortality risk associated with RLS may be driven by increased risk of death from suicide
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